No abstract available.
Peptic Ulcer Perforation* ; Peptic Ulcer*

No abstract available.
Hemorrhage*

No abstract available.
Hernia*

Anaphylactic deaths are frequently observed at autopsies. Since death associated with medical practice has become social concern, the identification of anaphylactic shock is an important part of forensic medicine. However, autopsy findings of anaphylactic shock are usually non-specific; therefore, the diagnosis of anaphylactic shock must be inferred from collecting data on the past history of the deceased, circumstances of death, and negative autopsy findings. The analysis of serum mast cell tryptase level is a well-known, useful ancillary test for the diagnosis of anaphylactic shock, but is not widely used in daily practice in Korea. We recently encountered 2 autopsy cases of anaphylactic shock and confirmed that analysis of serum mast cell tryptase level was useful for the diagnosis of anaphylactic shock. In this report, we present these 2 autopsy cases of anaphylactic shock, with literature review of the usefulness and limitations of serum mast cell tryptase analysis.
Anaphylaxis ; Autopsy ; Forensic Medicine ; Korea ; Mast Cells ; Tryptases

PURPOSE: Extensive involvement of the abdominal wall or the diaphragm by benign or malignant tumor usually has precluded wide excision. The major reason has been the lack of a satisfactory replacement for the abdominal wall or the diaphragm. When skin and subcutaneous tissues can be preserved, it is possible to restore the abdominal wall or diaphragm by using expanded polytetrafluoroethylene (GORE-TEX soft tissue patch). METHODS: From August 1993 to November 1999, we performed 6 reconstructions of the large abdominal wall or diaphragmatic defects using ePTFE following wide en bloc resection of the abdominal wall or diaphragm. RESULTS: The patients included 4 cases requiring a reconstruction of the abdominal wall. These consisted of one transverse colon cancer invading into the upper abdominal wall, a multiple teratoma recurring in the lower part of the abdominal wall, a recurrent cervix cancer inn the median line of the lower part of the abdominal wall, and an enormous desmoid tumor appearing in the right lower part of the abdominal wall. They were 22, 22, 8 and 4 months respectively after the surgical treatment. Diseases requiring extensive resection of the diaphragm included a case of hepatoma encroaching into the diaphragm and another case of a huge adrenal pheochromocytoma appearing in the right part of the diaphragm. They passed 8 and 4 months respectively following surgical treatment. There were no cases of wound infection or abdominal wall hernia, although seroma occurred in 2 cases (50%). CONCLUSION: In all 6 cases, a good result was achieved by restoring excised tissue using ePTFE graft after wide excision of tumors involving the abdominal wall or the diaphragm. Therefore, it may be possible to use this technique in cases of active excision of tumors that involve an extensive part of the abdominal wall or the diaphragm.
Abdominal Wall* ; Carcinoma, Hepatocellular ; Colon, Transverse ; Diaphragm ; Fibromatosis, Aggressive ; Hernia ; Humans ; Pheochromocytoma ; Polytetrafluoroethylene* ; Seroma ; Skin ; Subcutaneous Tissue ; Teratoma ; Transplants* ; Uterine Cervical Neoplasms ; Wound Infection

BACKGROUND: Epidural blocks are widely used for the management of acute and chronic pain. The technique of loss of resistance is frequently adopted to determine the epidural space. A discontinuity of the ligamentum flavum may increase the risk of failure to identify the epidural space. The purpose of this study was to investigate the anatomic variations of the cervical and high thoracic ligamentum flavum in embalmed cadavers. METHODS: Vertebral column specimens of 15 human cadavers were obtained. After vertebral arches were detached from pedicles, the dural sac and epidural connective tissue were removed. The ligamentum flavum from C3 to T6 was directly examined anteriorly. RESULTS: The incidence of midline gaps in the ligamentum flavum was 87%-100% between C3 and T2. The incidence decreased below this level and was the lowest at T4-T5 (8%). Among the levels with a gap, the location of a gap in the caudal third of the ligamentum flavum was more frequent than in the middle or cephalic portion of the ligamentum flavum. CONCLUSIONS: The cervical and high thoracic ligamentum flavum frequently has midline intervals with various features, especially in the caudal portion of the intervertebral space. Therefore, the ligamentum flavum is not always reliable as a perceptible barrier to identify the epidural space at these vertebral levels. Additionally, it may be more useful to insert the needle into the cephalic portion of the intervertebral space than in the caudal portion.
Analgesia, Epidural ; Cadaver ; Chronic Pain ; Connective Tissue ; Epidural Space ; Humans ; Incidence ; Ligamentum Flavum* ; Needles ; Spine

PURPOSE: Walter Whitehead introduced new method for treating circumferential hemorrhoids with good results for the first time in 1882, but his procedure has been neglected by most surgeons because of complications, such as anal stricture, incontinence, ectropion, etc. METHODS: We retrospectively inves tigated and analyzed 52 cases involving modified Whitehead hemorrhoidectomies (WH) and 60 cases involving submucosal hemorrhoidectomies (SH) performed at Seoul Adventist Hospital from Jan. 1989 to Dec. 1994. We only selected patients whose follow-up durations were more than 5 years. The chi-square test and t-test were used for the statistical analysis. RESULTS: The results are as follows: 1) The sex ratio of males to females was 1.36 to 1 in the WH group and 1.31 to 1 in the SH group. 2) The peak age was in the 4th decade (40.0% in the WH group and 35.0% in the SH group), the mean age was 39.1 years in the WH group and 37.3 years in the SH group, and the age distribution ranged from 17 years to 75 years in both groups. 3) The average postoperative hospital stay was 9.83 days in the WH group and 8.43 days in the SH group (p=0.001). 4) The average follow up duration was 71.3 months in the WH group and 76.9 months in the SH group. 5) In the WH and the SH groups, the postoperative complications were, respectively, recurrence (1.9%:0%, p=0.281), defecation difficulty (7.7%:1.7%, p=0.124), incontinence (1.9%:3.3%, p= 0.645), ectropion (1.9%:0%, p=0.281), anal pain (15.4%:8.3%, p=0.245), and anal bleeding (9.6%: 13.3%, p=0.540). 6) Some patients complained about complications 7 years after the operation. These were 1 defecation difficulty and 1 incontinence in the WH group and 1 defecation difficulty and 2 incontinences in the SH group. CONCLUSIONS: The results of a long term follow-up for postoperative complications after a modified Whitehead operation were no worse than those for a submucosal hemorrhoidectomy. Thus, if one uses proper surgical technique, one should be able to get better results: fewer complications and more complete healing of the hemorrhoid.
Age Distribution ; Constriction, Pathologic ; Defecation ; Ectropion ; Female ; Follow-Up Studies* ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Length of Stay ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Seoul ; Sex Ratio

BACKGROUND: The purpose of this study was to determine the cause of the axillary abnormalities seen in mammography and to evaluate the imaging characteristics of benign lymphadenopathy and lymphadenopathy associated with malignancy. METHODS: One hundred ninety-three (193) abnormalities seen mammographically were retrospectively reviewed and correlated with clinical diagnoses and pathologic results found in the medical records of patients treated from August 1997 to July 1998 at the National Medical Center. For each abnormality, the length, the margins and the presence of microcalcifications were noted. RESULTS: One hundred seventy-eight (178) patients had benigh lymphadenopathy and twelve patients had metastatic breast cancer. The mean lengths of lymph nodes in benign lymphadenopathy & metastatic breast cancer were 13.7 mm and 22 mm, respectively (p=0.0002). Fatty infiltrations of benign lymphadenopathy were seen 157 patients (88.2%) while eleven patients with metastatic breast cancers had nonfatty infiltration and one patient had fatty infiltration. Among the patient with benign lymphadenopathy circumscribed margins were observed in 167 patients (93.8%), microlobulated margins in 7 patients (3.9%), and obscured margins in 4 patients (2.2%), while among the patients with metastatic breast cancer circumscribed margins were seen in 6 patients, obscured margins in 3 patients, spiculated margins in 2 patients, and a microlobulated margin in 1 patient. No microcalcifications were found in lymph nodes. CONCLUSIONS: For benign lymphadenopathy the size of the abnormality was less than 13.7 mm and it had circumscribed margin and fatty center. On the other hand; homogenously dense (nonfatty) axillary lymph nodes were strongly associated with malignancy when axillary lymph nodes were longer than 22 mm with ill-defined or spiculated margins; therefore, a biopsy should be done to confirm malignancy in such cases.
Biopsy ; Breast ; Breast Neoplasms ; Diagnosis ; Hand ; Humans ; Lymph Nodes* ; Lymphatic Diseases ; Mammography ; Medical Records ; Retrospective Studies

Medicolegal autopsy is a vital tool for obtaining reliable injury mortality data. This study statistically analyzed data obtained from medicolegal autopsies performed in Korea in 2013. The aim of this study was to analyze various aspects of the 4,861 deaths that were categorized as unusual in Korea in 2013. A total of 4,861 deaths were analyzed by gender, age, manner of death, and cause of death. Of the 4,861 deaths, 3,542 (73.3%) were of men and 1,302 (26.7%) were of women. With respect to the manner of death, 54.4% were recorded as unnatural deaths, 38.8% were natural deaths, and 6.9% had unknown causes. Of the 2,642 unnatural deaths, 45.0% were determined to be accidental deaths, 26.3% suicidal, 16.9% homicidal, and 11.8% undetermined. Of the total number of unnatural deaths, 42.1% were trauma-related deaths, for which falling down accounted for 33.8%. Asphyxiation accounted for 16.0% of unnatural deaths, and of these, the predominant cause was hanging (58.8%). In addition, 14.4% of deaths were due to drowning, 12.9% poisoning, 11.0% thermal injuries, 1.8% complications arising from medical procedures, and 0.8% electrocution, starvation, or neglect. Among the 1,886 natural deaths, heart diseases accounted for 52.0% and vascular diseases accounted for 16.9%. Of the 196 deaths among children under the age of 10 years, 41.8% were recorded as unnatural deaths, 45.1% were natural deaths, and 1.5% had unknown causes.
Autopsy* ; Cause of Death ; Child ; Data Interpretation, Statistical ; Drowning ; Female ; Heart Diseases ; Humans ; Korea ; Male ; Mortality ; Poisoning ; Starvation ; Vascular Diseases

BACKGROUND: Epidural blocks are widely used for the management of acute and chronic pain. The technique of loss of resistance is frequently adopted to determine the epidural space. A discontinuity of the ligamentum flavum may increase the risk of failure to identify the epidural space. The purpose of this study was to investigate the anatomic variations of the cervical and high thoracic ligamentum flavum in embalmed cadavers. METHODS: Vertebral column specimens of 15 human cadavers were obtained. After vertebral arches were detached from pedicles, the dural sac and epidural connective tissue were removed. The ligamentum flavum from C3 to T6 was directly examined anteriorly. RESULTS: The incidence of midline gaps in the ligamentum flavum was 87%-100% between C3 and T2. The incidence decreased below this level and was the lowest at T4-T5 (8%). Among the levels with a gap, the location of a gap in the caudal third of the ligamentum flavum was more frequent than in the middle or cephalic portion of the ligamentum flavum. CONCLUSIONS: The cervical and high thoracic ligamentum flavum frequently has midline intervals with various features, especially in the caudal portion of the intervertebral space. Therefore, the ligamentum flavum is not always reliable as a perceptible barrier to identify the epidural space at these vertebral levels. Additionally, it may be more useful to insert the needle into the cephalic portion of the intervertebral space than in the caudal portion.
Analgesia, Epidural ; Cadaver ; Chronic Pain ; Connective Tissue ; Epidural Space ; Humans ; Incidence ; Ligamentum Flavum ; Needles ; Spine